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Published on: December 14, 2020
Pediatric esophageal high-resolution manometry: utility of a standardized protocol and size-adjusted pressure
Helena A S Goldani1, Annamaria Staiano, Osvaldo Borrelli
1Paediatric Gastroenterology Unit, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Insights
This study introduces a standardized esophageal high-resolution manometry (EHRM) protocol for children, identifying key pressure parameters for diagnosing pediatric esophageal motility disorders and evaluating a new metric for peristaltic dysfunction.
Area of Science:
- Pediatric Gastroenterology
- Esophageal Physiology
- Diagnostic Tools
Background:
- Esophageal high-resolution manometry (EHRM) is increasingly used in adults.
- A standardized protocol for pediatric EHRM is needed for routine clinical practice.
Purpose of the Study:
- To propose and evaluate a standardized EHRM protocol for pediatric patients.
- To assess esophageal motility disorders in children using EHRM.
Main Methods:
- Thirty pediatric patients underwent unsedated EHRM using customized catheters.
- Evaluated single wet swallows, multiple rapid swallows (MRS), and solid swallows.
- Analyzed esophageal pressure topography and introduced a new metric, DCIa.
Main Results:
- Identified normal peristalsis, peristaltic dysfunction, achalasia, and esophageal spasm.
- Patients with peristaltic dysfunction showed significantly lower DCIa (P<0.001).
- MRS and solid swallows revealed specific patterns in achalasia and severe dysfunction.
Conclusions:
- The standardized EHRM protocol provides objective pressure data for pediatric esophageal motility disorders.
- The DCIa metric shows promise for assessing pediatric peristaltic dysfunction.
Objectives:
Esophageal high-resolution manometry (EHRM) has evolved rapidly from a research tool to a routine investigation in adult clinical practice. This study proposes and evaluates a standardized EHRM protocol for use in pediatric clinical practice.
Methods:
Thirty pediatric patients underwent unsedated EHRM. Indications for EHRM were dysphagia, feeding difficulty, or pre-fundoplication assessment. Two 20-channel customized water-perfused silicone catheters, with an outside diameter of 3.8 mm (MuiScientific, Ontario, CA), were used. The catheters had one distal gastric channel, five channels 0.5 cm apart for the e-sleeve, and 14 proximal channels either 1 cm (for children <5 years) or 2 cm apart (for children >5 years). Single wet swallows, multiple rapid swallows (MRS), and solid swallows were systematically studied.
Results:
The median age was 10 years (range 6 months-15 years). The esophageal motor findings were normal peristalsis (n=15), peristaltic dysfunction (n=12), achalasia (n=3), and spasm on consumption of solid food (n=2). The distal contractile integral adjusted for esophageal length (DCIa) of patients with peristaltic dysfunction was significantly lower than that of patients without peristaltic dysfunction (P<0.001). On MRS, aperistalsis with lack of esophagogastric junction (EGJ) relaxation was observed in patients with achalasia, and aperistalsis with complete EGJ relaxation was observed in patients with severe peristaltic dysfunction. On consumption of solid food, esophageal spasm associated with bolus impaction was observed in two patients.
Conclusions:
This study provides objective information with regard to topography pressure parameters in esophageal motility disorders of childhood while using a standardized EHRM protocol. The new DCIa variable may be useful for the assessment of patients with peristaltic dysfunction.
